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Current concepts and management of the enigmatic thyroid nodule
S66
Ultrasound in Medicine & Biology
do baseline fertility scan and explaining what information fertility specialists want to know and why. It will answer the questions of the how, when, and why. You may have heard of the term Antral Follicle Count (AFC) and wondered what that is and how to do it? This presentation will cover this topic and much more.
SESSION 13G: GENERAL HEAD & NECK Current concepts and management of the enigmatic thyroid nodule Christopher Low Consultant Otolaryngology Head & Neck Surgery, Bay of Plenty District Health Board, Tauranga, New Zealand The style of lecturing is relaxed and interactive. The lecturer aims to deliver an overview on the current concepts and management of thyroid nodules through the eyes of the clinician. It will expose issues within the current management strategies and potential solutions will be explored. Delegates will appreciate the importance of a multidisciplinary approach in managing the complex issues and the challenges encountered within the disciplines. The key role of the ultrasound scan in thyroid cancer management and how improvements can be made in diagnostics and follow-ups, will be discussed. The lecturer will encourage collaborative practice with clinicians in order to find solutions to meet the challenges, ultimately to improve patient care.
Thyroid classification: Where have we been and where are we going? Martin Necas Specialist Sonographer, Waikato Hospital, Department of Radiology Ultrasound, Hamilton, New Zealand Ultrasound is the most common imaging technique for the assessment of the thyroid gland. Thyroid disease can be focal (nodule) or diffuse (multinodular thyroid, Grave’s, Hashimoto’s thyroiditis, subacute viral thyroiditis). While ultrasound provides excellent anatomical depiction of the thyroid gland, ultrasound is not a histological examination. Because virtually any nodule containing solid tissue represent a malignancy, numerous rules, guidelines and scoring systems have been used in an effort to stratify the risk based on a wide variety of anatomical features including: size, composition, shape, echogenicity, echotexture, margins, presence and nature of calcifications. Two different strategies have been used in the development of thyroid nodule classification systems. One strategy relies on pattern-recognition and the other relies on numerical scoring of each nodule. In this presentation, we will review and compare these strategies and discuss what they mean for the practitioner. Specific advice will be provided for non-clinician practitioners (sonographers) on how to improve the efficiency of the thyroid examination and avoid becoming paralysed by the high-level of cognitive detail in patients with multinodular thyroid glands.
Post-operative thyroid US evaluation Maria Cristina Chammas Director of Ultrasound Division, School of Medicine, University of S~ ao Paulo, Brazil Thyroid cancer is the most common endocrine malignancy. The increased incidence of differentiated thyroid carcinoma (DTC) in the past few decades is likely due to more intensive imaging and the detection of early stage disease. Local recurrence can be found in the thyroid bed or the residual thyroid tissue and regional recurrence in the lymph nodes of the central or lateral compartments of the neck.
Volume 45, Number S1, 2019 Although recurrences are relatively common and may occur years after initial treatment, mortality rates of DTC remain very low. The primary surveillance paradigm now used for most treated DTC patients at low risk for disease recurrence consists of serial serum thyroglobulin measurements and focused cervical US. Neck ultrasonography (US) is recommended for the assessment of all patients with thyroid carcinoma after initial therapy, since even low-risk patients with undetectable stimulated thyroglobulin (Tg) may present cervical metastases. Cervical lymph node metastases have been reported to occur in 12 81% of patients with papillary thyroid cancer (PTC), and in a smaller proportion of patients with other histotypes (i.e., follicular thyroid cancer and Hu€rthle cell carcinoma) Besides, recurrences, there are other differential diagnostic for thyroid bed nodules, as enlarged parathyroid and lymph nodes. Specific US findings of recurrent tumor in the neck include cystic changes, microcalcifications, and clustering of rounded lymph nodes. The color Doppler US can be useful helping to distinguish between malignant and benign nodules (both in the thyroid bed and lymph nodes). The flow analysis usually revealing peripheral or mixed hypervascularization in malignant cases. In the presence of “suspicious” lymph nodes upon US, fine-needle aspiration cytology and measurement of Tg in the needle lavage fluid are useful and complementary exams for the definition of the etiology, with the combination of the two methods showing elevated sensitivity and 100% specificity.
SESSION 13H: WFUMB EDUCATION Overview and challenges of WFUMB CoEs Dieter Nuernberg Professor for Gastroenterology, Medical School Brandenburg Theodor Fontane, Neuruppin, Germany The education program is a very important part of the WFUMB work. The WFUMB Centers of Education (COEs) shall provide qualification in medical ultrasound in underserved regions and in countries where are deficits in US education program. They should grant recognition for to participants after completion of courses, accumulate ultrasound related reference materials and serve as reference centers for the region, they are situated (www.wfumb.org). Today 14 COE all over the world are accredited. There are 3 types of COEs; Type 1 with basic education in one speciality; Type 2 provides basic and advanced education in one specialty and Type 3 is a multidisciplinary centre with advanced education in two or more specialities. We have now 5 COEs in Africa (Togo, Sudan, Ethiopia, Tanzania, Kenia), 2 in South America (Venezuela, Paraguay), 4 in Asia (Bangladesh, Mongolia, Indonesia, Vietnam) and 3 in Europe (Rumania, Moldova, Albania). There are 4 Terms of COEs: 1. COE Candidate: The COE Task Force Group is looking for COE new candidates. This period should not be longer than 2 years during which time the agreement will be prepared. 2. COE: After evaluation the COE will get higher support from WFUMB for 3 years 3. Established COE: WFUMB support is available for a further 2 years 4. Independent COE: After this time the COE should work independent without financial support from WFUMB but under supervision/umbrella of WFUMB. COEs should offer: 1. Ultrasound courses (basic, advanced and for special fields and techniques) at regular intervals. 2. Training facilities for long term education in practical ultrasound. 3. Library and teaching material. 4. E-learning education and 5. Students education. WFUMB founded a COE Task Force Group to improve the number of COEs in the next few years.
Ultrasound in Medicine & Biology
do baseline fertility scan and explaining what information fertility specialists want to know and why. It will answer the questions of the how, when, and why. You may have heard of the term Antral Follicle Count (AFC) and wondered what that is and how to do it? This presentation will cover this topic and much more.
SESSION 13G: GENERAL HEAD & NECK Current concepts and management of the enigmatic thyroid nodule Christopher Low Consultant Otolaryngology Head & Neck Surgery, Bay of Plenty District Health Board, Tauranga, New Zealand The style of lecturing is relaxed and interactive. The lecturer aims to deliver an overview on the current concepts and management of thyroid nodules through the eyes of the clinician. It will expose issues within the current management strategies and potential solutions will be explored. Delegates will appreciate the importance of a multidisciplinary approach in managing the complex issues and the challenges encountered within the disciplines. The key role of the ultrasound scan in thyroid cancer management and how improvements can be made in diagnostics and follow-ups, will be discussed. The lecturer will encourage collaborative practice with clinicians in order to find solutions to meet the challenges, ultimately to improve patient care.
Thyroid classification: Where have we been and where are we going? Martin Necas Specialist Sonographer, Waikato Hospital, Department of Radiology Ultrasound, Hamilton, New Zealand Ultrasound is the most common imaging technique for the assessment of the thyroid gland. Thyroid disease can be focal (nodule) or diffuse (multinodular thyroid, Grave’s, Hashimoto’s thyroiditis, subacute viral thyroiditis). While ultrasound provides excellent anatomical depiction of the thyroid gland, ultrasound is not a histological examination. Because virtually any nodule containing solid tissue represent a malignancy, numerous rules, guidelines and scoring systems have been used in an effort to stratify the risk based on a wide variety of anatomical features including: size, composition, shape, echogenicity, echotexture, margins, presence and nature of calcifications. Two different strategies have been used in the development of thyroid nodule classification systems. One strategy relies on pattern-recognition and the other relies on numerical scoring of each nodule. In this presentation, we will review and compare these strategies and discuss what they mean for the practitioner. Specific advice will be provided for non-clinician practitioners (sonographers) on how to improve the efficiency of the thyroid examination and avoid becoming paralysed by the high-level of cognitive detail in patients with multinodular thyroid glands.
Post-operative thyroid US evaluation Maria Cristina Chammas Director of Ultrasound Division, School of Medicine, University of S~ ao Paulo, Brazil Thyroid cancer is the most common endocrine malignancy. The increased incidence of differentiated thyroid carcinoma (DTC) in the past few decades is likely due to more intensive imaging and the detection of early stage disease. Local recurrence can be found in the thyroid bed or the residual thyroid tissue and regional recurrence in the lymph nodes of the central or lateral compartments of the neck.
Volume 45, Number S1, 2019 Although recurrences are relatively common and may occur years after initial treatment, mortality rates of DTC remain very low. The primary surveillance paradigm now used for most treated DTC patients at low risk for disease recurrence consists of serial serum thyroglobulin measurements and focused cervical US. Neck ultrasonography (US) is recommended for the assessment of all patients with thyroid carcinoma after initial therapy, since even low-risk patients with undetectable stimulated thyroglobulin (Tg) may present cervical metastases. Cervical lymph node metastases have been reported to occur in 12 81% of patients with papillary thyroid cancer (PTC), and in a smaller proportion of patients with other histotypes (i.e., follicular thyroid cancer and Hu€rthle cell carcinoma) Besides, recurrences, there are other differential diagnostic for thyroid bed nodules, as enlarged parathyroid and lymph nodes. Specific US findings of recurrent tumor in the neck include cystic changes, microcalcifications, and clustering of rounded lymph nodes. The color Doppler US can be useful helping to distinguish between malignant and benign nodules (both in the thyroid bed and lymph nodes). The flow analysis usually revealing peripheral or mixed hypervascularization in malignant cases. In the presence of “suspicious” lymph nodes upon US, fine-needle aspiration cytology and measurement of Tg in the needle lavage fluid are useful and complementary exams for the definition of the etiology, with the combination of the two methods showing elevated sensitivity and 100% specificity.
SESSION 13H: WFUMB EDUCATION Overview and challenges of WFUMB CoEs Dieter Nuernberg Professor for Gastroenterology, Medical School Brandenburg Theodor Fontane, Neuruppin, Germany The education program is a very important part of the WFUMB work. The WFUMB Centers of Education (COEs) shall provide qualification in medical ultrasound in underserved regions and in countries where are deficits in US education program. They should grant recognition for to participants after completion of courses, accumulate ultrasound related reference materials and serve as reference centers for the region, they are situated (www.wfumb.org). Today 14 COE all over the world are accredited. There are 3 types of COEs; Type 1 with basic education in one speciality; Type 2 provides basic and advanced education in one specialty and Type 3 is a multidisciplinary centre with advanced education in two or more specialities. We have now 5 COEs in Africa (Togo, Sudan, Ethiopia, Tanzania, Kenia), 2 in South America (Venezuela, Paraguay), 4 in Asia (Bangladesh, Mongolia, Indonesia, Vietnam) and 3 in Europe (Rumania, Moldova, Albania). There are 4 Terms of COEs: 1. COE Candidate: The COE Task Force Group is looking for COE new candidates. This period should not be longer than 2 years during which time the agreement will be prepared. 2. COE: After evaluation the COE will get higher support from WFUMB for 3 years 3. Established COE: WFUMB support is available for a further 2 years 4. Independent COE: After this time the COE should work independent without financial support from WFUMB but under supervision/umbrella of WFUMB. COEs should offer: 1. Ultrasound courses (basic, advanced and for special fields and techniques) at regular intervals. 2. Training facilities for long term education in practical ultrasound. 3. Library and teaching material. 4. E-learning education and 5. Students education. WFUMB founded a COE Task Force Group to improve the number of COEs in the next few years.